Medical Ethics: Beneficence and Non-maleficence

Beneficence and Non-maleficence are two interrelated concepts which consist of bringing no harm to others. Although the two are interrelated, there is a big difference between the two. Beneficence refers to the act of helping others whereas non-maleficence refers to not doing any harm. Therefore, the main difference between the two is that beneficence asks that you help others while non-maleficence asks that you do no harm to others to begin with. When you combine both concepts, the main point is that you must act selflessly in a way that will help the other individual and you must not act on your own beliefs.

As mentioned before, beneficence refers to the actions that help others. In other words, these actions are done for the benefit of others. According to the UCSF school of medicine, “beneficence is an action that is done for the benefit of others. Beneficent actions can be taken to help prevent or remove harm or to simply improve the situations of others” (Pantilat, 2008). The UCSF school of medicine also provides clinical applications in which they mention how physicians are “expected to refrain from causing harm, but they also have an obligation to help their patients” (Pantilat, 2008). It certainly seems confusing considering the fact that sometimes in order to provide care, patients can experience harm. UCSF also mentions that there is a difference between obligatory and ideal beneficence. UCSF mentions that there is a common confusion between ideal beneficence and obligatory beneficence. According to the UCSF school of medicine, “Ideal beneficence compromises extreme acts of generosity or attempts to benefit others on all possible occasions” (Pantilat, 2008).

According to the UCSF, “physicians are not necessarily expected to live up to this broad definition of beneficence,” however they most certainly are required to promote the welfare of patients no matter what (Pantilat, 2008). Because of the knowledge that physicians possess, they are obligated to prevent and remove harm and “weigh and balance possible benefits against possible risk of an action” (Pantilat, 2008). Not only this but the UCSF expands on the definition of beneficence by saying this can also include “protecting and defending the rights of others, rescuing persons who are in danger, and helping individuals with disabilities” (Pantilat, 2008). The following are a few examples the UCSF provides in regard to beneficence: “resuscitating a drowning victim, providing vaccinations for the general population, or helping someone quit smoking” (Pantilat, 2008).

Non-maleficence as defined earlier basically states that you must do no harm no matter what and refrain from providing “ineffective treatment or acting with malice toward patients” (Pantilat, 2008). UCSF makes a point to say that this principle offers little useful guidance because many times therapies or treatment provided by physicians can also have serious risks or consequences (Pantilat, 2008)). According to the UCSF, “physicians should not provide ineffective treatments to patients as these offer risk with no possibility of benefit and thus have a change of harming patients” (Pantilat, 2008). The school of medicine continues to say that, “In addition, physicians must not do anything that would purposely harm patients without the action being balanced by proportional benefit” (Pantilat, 2008).

The reason UCSF says this is because they believe that many procedures and interventions can cause harm in relation to benefits and therefore, the physician must make sure to inform the patient of all risks prior to any procedures. And ultimately, the physician should not pressure the patient into having any procedure done and should solely allow the patient to decide based on the proper information provided to him or her. An example of non-maleficence is stopping any medication that is shown to be harmful or refusing to provide treatment to a patient which has not been proven to be effective in trials. Another example of non-maleficence is not encouraging someone to smoke when you know how harmful it can be.

The four pillars of medical ethics (essay)

The four pillars of medical ethics are Autonomy, Beneficence, Non-maleficence and Justice, all of them have extreme importance in providing a high standard of service in line with the guidance from the General Medical Council (GMP). Autonomy refers to patients freedom of choice in regards to their health and treatment. Beneficence is to provide a health benefit. Non-Maleficence is to ‘do no harm.’ And justice finally remarks on treating patients of similar circumstances equally.

In my opinion, the most important pillar is non-maleficence, a principle that ensures the overall well being of the patient. For example, a high-risk pregnancy which poses a risk to both the mother and the fetus, here the doctor would need to carry out a risk assessment of ‘empirical information’ to decide how best to treat them to prevent further damage. Non-maleficence is often referred to be the ‘sister’ of beneficence in the sense that one cannot be done without the other. To benefit the patient you would need to make sure there is also no harm being done. This is usually the main reason most choose a profession in medicine, to help people get better, both mentally and physically.

It could also be argued that another important principle is patient autonomy. A patient should be able to decide which treatments to undergo that best fits their values and beliefs as long as they have the ‘capacity.’ A patient having no say in their treatment may worsen their condition in cases where they believe their religious spiritual beliefs are being breached, harming their mental health. For example, the same woman may decide to refuse an abortion in case of a life-threatening pregnancy due to religious reasons. In this case, a doctor forcefully aborting the fetus deviates from the guidelines set by the GMP where it is outlined a doctor must ‘have consent or other valid authority’ before providing treatment.

However, abiding by her choices may lead to her death conflicting with the principle of non-maleficence. The prima facie nature of these principles means that these principles are ‘binding unless it conflicts with another moral principle – if it does we have to choose between them.’ Hence leading to the doctor having to respect her autonomy provided that she has the ‘capacity’ to decide. On the other hand, it would be difficult to assess and create a clear judgement of exactly who is mentally capable and to what extent. For example, if the same woman suffered from a mental disorder such as a personality disorder, she could be said to lack the ‘capacity’ to choose which treatments she undergoes and therefore her autonomy would not be respected allowing doctors to follow the principle of beneficence and non-maleficence.

Also, justice is integral to providing a good clinical service and maintaining trust as required by the GMP. Priority to patients should only be given on ‘the basis of their clinical need’ and nor should you ‘unfairly discriminate against patients’. This could again be applied to the context of the pregnant woman who is suffering complications and therefore requiring more time and resources than another pregnant woman who has no implications. Having said that, if this high-risk pregnancy received more care than another high-risk pregnancy it would be deemed unacceptable as both women are suffering from the same condition and therefore require similar levels of care.

In conclusion, I believe that non-maleficence is the driving force behind all of the principles, emphasizing its importance in the medical world. Failing to follow the other principles eventually has a knock-on effect on non-maleficence. For example, being unjust to a patient by providing them less than the necessary care would lead to their condition deteriorating.

Works Cited

1. Beauchamp, T. L., & Childress, J. F. (2019). Principles of Biomedical Ethics. Oxford University Press.
2. General Medical Council. (2013). Good Medical Practice. Retrieved from https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/good-medical-practice
3. Macklin, R. (2003). Double Effect and the Principle of Nonmaleficence: A Reply to Professor Veatch. Kennedy Institute of Ethics Journal, 13(3), 221-235.
4. Pantilat, S. Z. (2008). Beneficence and Nonmaleficence. In G. J. Ebrahim (Ed.), Clinical Ethics in Anesthesiology: A Case-Based Textbook (pp. 3-7). Cambridge University Press.
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8. Schöne-Seifert, B., & Yarborough, M. (2012). The Principle of Beneficence in Applied Ethics. The Stanford Encyclopedia of Philosophy (Winter 2012 Edition). Retrieved from https://plato.stanford.edu/archives/win2012/entries/principle-beneficence/
9. Sulmasy, D. P. (2019). What is Ethics in Medicine?: Conflicting Norms and the Moral Obligations of Physicians. Journal of Medicine and Philosophy, 44(1), 1-15.
10. Veatch, R. M. (1995). The Principle of Double Effect: In Reply to Professor Macklin. Kennedy Institute of Ethics Journal, 5(3), 235-243.